Supervisor, RN Clinical

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POSITION SUMMARY

The Supervisor - RN Clinical is responsible for managing the daily operations of the clinical team in the area of medical management operations, inclusive, but not limited to maintaining production metrics, delivering on current service level agreements, fulfilling contractual requirements and supporting future state initiatives while meeting strategic, operational and budgetary targets. Additionally this position will partner with leadership to continue the development of clinical quality programs. In collaboration with key business partners, the Supervisor – RN Clinical will identify operational opportunities and areas for process development, improvement and administration applicable to clinical product offerings and present recommendations to leadership.

ESSENTIAL FUNCTIONS

  • Monitor operational performance relating to Operational metrics, Quality measures, Contractual requirements, Execution of MBM policies and procedures and Clinical appropriateness.
  • Monitor the daily administration of clinical programs, including application of medical policy, utilization management processes and practices while remaining compliant with contractual and regulatory requirements.
  • Serve as a point of escalation for issues requiring a higher degree of expertise or discretion to resolve.
  • Provides department leadership in the area of staff performance including mentoring, auditing, productivity monitoring and coaching for success. Corresponds with management on employee/HR issues, state of the department and any service issues involving key clients or legal risk issues to the company.
  • Analyze reporting data trends within team relative to quality to ensure efficiency and productivity requirements are maximized. Provide feedback to team related to productivity and efficiency.
  • Continual identification of operational opportunities to gain efficiencies, improve processes and workflow and develop best practices.

QUALIFICATIONS

  • Bachelor’s degree in relevant discipline or equivalent experience
  • 2-5 years relevant experience or Master’s degree
  • Licensures/Certifications: Registered Nurse
  • Solid PC navigation skill set
  • Working knowledge of Microsoft Office
  • Excellent verbal and written communication and presentation skills
  • Solid understanding of the health insurance industry
  • Ability to navigate and support both public and private insurance/plan requirements
  • Managed care exposure; Understanding or ability to implement utilization management principles
  • Proven leader in a clinical ops environment

ABOUT THE DEPARTMENT

The Client Services department manages client requests related to benefit design adds and changes across all business units servicing many members. Independently manage and track all benefit design requests to ensure timelines are met including the proactive management of client specific performance guarantees. Manage all benefit design requests to ensure high quality results are consistently met for ESI clients and members thus mitigating financial and/or member disruption. Communicates clearly and professionally with both external and internal partners related to all aspects of benefit set up.

ABOUT EXPRESS SCRIPTS

Advance your career with the company that makes it easier for people to choose better health.

Employer is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.

Employer is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Employer is a VEVRAA Federal Contractor.

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